Management of spiral diaphyseal fractures of the fifth metatarsal: A case series and a review of literature

Morgan, Catrin; Abbasian, Ali

doi:10.1016/j.foot.2019.101654

Cited by 10 publications

(18 citation statements)

References 8 publications

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“…In general, non-operative treatment is preferred for these fractures and is quite effective leaving no sequela even in competitive athletes (115,116). In a recent study, 33 patients were treated with a boot or a hard-sole shoe with a minimum of 10 months follow-up and showed excellent outcomes regardless of the degree of displacement, shortening, or rotation.…”

Section: Dancer's Fracture -Diaphyseal Spiral Fracturementioning

confidence: 99%

Fifth metatarsal fractures: an update on management, complications, and outcomes

Chloros

Kakos²,

Tastsidis

et al. 2022

EFORT Open Reviews

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Even though fifth metatarsal fractures represent one of the most common injuries of the lower limb, there is no consensus regarding their classification and treatment, while the term ‘Jones’ fracture has been used inconsistently in the literature. In the vast majority of patients, Zone 1 fractures are treated non-operatively with good outcomes. Treatment of Zone 2 and 3 fractures remains controversial and should be individualized according to the patient’s needs and the ‘personality’ of the fracture. If treated operatively, anatomic reduction and intramedullary fixation with a single screw, with or without biologic augmentation, remains the ‘gold standard’ of management; recent reports however report good outcomes with open reduction and internal fixation with specifically designed plating systems. Common surgical complications include hardware failure or irritation of the soft tissues, refracture, non-union, sural nerve injury, and chronic pain. Patients should be informed of the different treatment options and be part of the decision process, especially where time for recovery and returning to previous activities is of essence, such as in the case of high-performance, elite athletes.

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Section: Dancer's Fracture -Diaphyseal Spiral Fracturementioning

confidence: 99%

Fifth metatarsal fractures: an update on management, complications, and outcomes

Chloros

Kakos²,

Tastsidis

et al. 2022

EFORT Open Reviews

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“…Based on the limited available literature, delayed union and nonunion have been found in 3% to 9% [ 7 , 8 ] of patients in the general population who were treated nonoperatively. For patients aged ≥40 years, the delayed union rate for nonsurgical treatment is 35% [ 5 ].…”

Section: Methodsmentioning

confidence: 99%

The Clinical Outcomes of Operative Treatment Versus Conservative Treatment for Dancer’s Fractures: Protocol for a Retrospective Cohort Study

Ruijter¹,

Yuan²,

Derksen³

2022

JMIR Res Protoc

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Background Fifth metatarsal fractures are one of the most common foot fractures, and 11% to 25% of such fractures are Dancer’s fractures (distal spiral fractures). Conservative therapy while wearing a cast and operative treatment have been used as preferred modes of treatment in the limited literature available. However, we often see healing problems, such as delayed union and nonunion, when Dancer’s fractures are treated nonoperatively, resulting in a need for secondary intervention. In our institution, treatment has changed over the years from predominantly conservative treatment to mostly operative treatment. To investigate whether our hypothesis holds true that primary surgical treatment is beneficial, a retrospective study was designed. Objective The objective of the study is to compare differences between outcomes (delayed union and nonunion) of conservative and operative treatments for Dancer’s fractures. Methods A retrospective comparative cohort study will be conducted in a level II trauma center (Zaandam Medical Center). Patients who experienced a Dancer’s fracture in the period of 2012 to 2021 will be included and divided into 2 cohorts—the conservative (2012-2015) and operative (2016-2021) treatment cohorts. The primary outcome will be the differences in percentages of delayed union and nonunion between the two groups. The secondary outcomes will be the percentage of primary conservative treatment failure, the need for secondary operative treatment, complications (infection and hardware failure), and functional outcomes. If 118 patients are included in each group, sufficient power is expected to be reached, depending on the age distribution of patients. The percentages of delayed union and nonunion among the two groups will be calculated and statistically compared via chi-square statistics. A logistic regression analysis will be used to investigate possible associations between patient characteristics and failed conservative treatment. A Mann-Whitney U test will be used to compare functional outcomes between groups. An independent, 2-tailed t test will be used to compare mean 12-Item Short Form Survey scores if they are normally distributed, and a Wilcoxon rank sum test will be used if they are nonnormally distributed. Results In total, 2134 potentially relevant health insurance codes have been extracted from the hospital’s register. We expect to find a total of 236 Dancer’s fractures in this data set. Conclusions Our study has limitations due to it being a single-center study and data collection being performed retrospectively. However, it covers a large time period and may provide the possibility to show treatment outcome differences (delayed union and nonunion, complications, and functional outcomes) in 2 reasonably large cohorts (conservative and operative treatment cohorts), which has not been done before in literature on Dancer’s fractures. If our hypothesis that surgery is beneficial for Dancer’s fractures is proven true by our study, we plan to further corroborate it by conducting a prospective randomized controlled trial. International Registered Report Identifier (IRRID) PRR1-10.2196/37171

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“…After removing duplicates and screening the articles based on inclusion and exclusion criteria, 10 studies were included (Figure 1). There was one study of LOE II [4], five studies of LOE III [6,9,12,16,20] and four studies of LOE IV [1,9,10,15]. There was one study of low risk of bias [4], four studies of moderate risk of bias [9,12,16,20] and five studies of serious risk of bias [1,6,10,15,22] (Table 2).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The majority of dancer's fractures are minimally displaced and are nonangulated and thus are managed nonoperatively via immobilisation, with satisfactory clinical and radiological outcomes reported in the literature [1,4,6,12,15,16,20]. There is controversy surrounding the optimal method of immobilisation by either rigid-soled shoes, casts, splints or walking boots.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of spiral oblique fractures of the fifth metatarsal leads to faster return to play in athletes: A systematic review

Jimenez Mosquea,

Butler,

Samsonov

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this systematic review was to evaluate outcomes following both operative and nonoperative management of spiral oblique fractures of the fifth metatarsal.MethodsDuring November 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following operative and nonoperative management of dancer's fractures. Data regarding subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed.ResultsTen studies were included in this review. In total, 125 patients underwent operative treatment for dancer's fractures and 365 patients underwent nonoperative treatment for dancer's fractures. The weighted mean follow‐up in the operative cohort was 15.3 ± 32.7 months and the weighted mean follow‐up in the nonoperative cohort was 30.6 ± 24.3 months. The overall union rate in the operative cohort was 99.2% and the overall union rate in the nonoperative cohort was 98.6%. The weighted mean time to return to sport was 15.4 ± 6.7 and 22.4 ± 4.4 weeks in the operative cohort and nonoperative cohort, respectively. The complication rate in the operative cohort and nonoperative cohort was 12.0% and 15.1%, respectively.ConclusionThis current systematic review demonstrated comparable radiographic outcomes together with low failure rate and low complication rate following both operative and nonoperative management of dancer's fracture at short‐term follow‐up. However, faster return to sport rates was observed in the operative cohort, suggesting that surgical management of displaced spiral oblique fractures of the fifth metatarsal should be the mainstay treatment option. However, the under‐reporting of data, marked heterogeneity between studies and paucity of comparative studies limits the generation of any robust conclusions; thus, further high‐quality comparative studies are warranted.Level of EvidenceLevel IV.

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Management of spiral diaphyseal fractures of the fifth metatarsal: A case series and a review of literature

Cited by 10 publications

References 8 publications

Fifth metatarsal fractures: an update on management, complications, and outcomes

Fifth metatarsal fractures: an update on management, complications, and outcomes

The Clinical Outcomes of Operative Treatment Versus Conservative Treatment for Dancer’s Fractures: Protocol for a Retrospective Cohort Study

Surgical management of spiral oblique fractures of the fifth metatarsal leads to faster return to play in athletes: A systematic review

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